Aids

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{{Infobox_Disease |Name = Acquired immunodeficiency syndrome (AIDS) | Image = Red_Ribbon.svg | Caption = The [Red ribbon#AIDS awareness symbol is a symbol for solidarity with HIV-positive people and those living with AIDS. | Width = 120 | DiseasesDB = 5938 | ICD10 = {{ICD10|B|24||b|20--> | ICD9 = {{ICD9|042--> | ICDO = | OMIM = | MedlinePlus = 000594 | eMedicineSubj = emerg | eMedicineTopic = 253 | MeshID = D000163 | -->Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a syndrome resulting from the specific damage to the immune system caused by the HIV (HIV) in humans,{{cite journal | author=Marx, J. L. | title=New disease baffles medical community | journal=Science | year=1982 | pages=618–621 | volume=217 | issue=4560 | id={{PMID |7089584-->

--> and similar viruses in other species (Simian immunodeficiency virus, Feline immunodeficiency virus, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to decelerate the virus' progression, there is currently no known cure. HIV, et al., are Transmission (medicine) through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.{{

cite web]| publisher=Centers for Disease Control & Prevention ]| publisher=| year= 2006-04-14, [vaginal sex or oral sex Sexual intercourse, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids.

Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century;

{{ cite journal], with an estimated 38.6 million people now living with the disease worldwide.{{

cite book]| year = 2006| title = 2006 Report on the global AIDS epidemic| chapter = Overview of the global AIDS epidemic| chapterurl = http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH02_en.pdf| accessdate = 2006-06-08| format= PDF--> As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981, making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, of which more than 570,000 were children. A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth and destroying human capital. antiretroviral drug treatment reduces both the Mortality rate and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.{{

cite journal] is more severe than that associated with other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.

Infection by HIV of HIV-1 budding from cultured lymphocyte.

AIDS is the most severe acceleration of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as T helper cell (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. Acute (medical) HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified on the basis of the amount of CD4+ T cells in the blood and the presence of certain infections.

In the absence of antiretroviral drugs, the median HIV Disease Progression Rates is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.{{

cite journal | author=Morgan, D., Mahe, C., Mayanja, B., Okongo, J. M., Lubega, R. and Whitworth, J. A. | title=HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries? | journal=AIDS | year=2002 | pages=597–632 | volume=16 | issue=4 | id={{PMID |11873003-->

--> However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.{{

cite journal | author=Clerici, M., Balotta, C., Meroni, L., Ferrario, E., Riva, C., Trabattoni, D., Ridolfo, A., Villa, M., Shearer, G.M., Moroni, M. and Galli, M. | title=Type 1 cytokine production and low prevalence of viral isolation correlate with long-term non progression in HIV infection | journal=AIDS Res. Hum. Retroviruses. | year=1996 | pages=1053–1061 | volume=12 | issue=11 | id={{PMID |8827221-->

-->{{

cite journal | author=Morgan, D., Mahe, C., Mayanja, B. and Whitworth, J. A. | title=Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study | journal=BMJ | year=2002 | pages=193–196 | volume=324 | issue=7331 | id={{PMID |11809639-->

--> Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression.{{

cite journal | author=Gendelman, H. E., Phelps, W., Feigenbaum, L., Ostrove, J. M., Adachi, A., Howley, P. M., Khoury, G., Ginsberg, H. S. and Martin, M. A. | title=Transactivation of the human immunodeficiency virus long terminal repeat sequences by DNA viruses | journal=Proc. Natl. Acad. Sci. U. S. A. | year=1986 | pages=9759–9763 | volume=83 | issue=24 | id={{PMID |2432602-->

-->{{

cite journal | author=Bentwich, Z., Kalinkovich., A. and Weisman, Z. | title=Immune activation is a dominant factor in the pathogenesis of African AIDS. | journal=Immunol. Today | year=1995 | pages=187–191 | volume=16 | issue=4 | id={{PMID |7734046-->

--> The infected person's genetics plays an important role and some people are resistance (biology) to certain strains of HIV. An example of this is people with the CCR5-Δ32 mutation are resistant to infection with certain strain (biology) of HIV.{{

cite journal | author=Tang, J. and Kaslow, R. A. | title=The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy | journal=AIDS | year=2003 | pages=S51–S60 | volume=17 | issue=Suppl 4 | id={{PMID |15080180-->

--> HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.{{

cite journal | author=Quiñones-Mateu, M. E., Mas, A., Lain de Lera, T., Soriano, V., Alcami, J., Lederman, M. M. and Domingo, E. | title=LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression | journal=Virus Research | year=1998 | pages=11–20 | volume=57 | issue=1 | id={{PMID |9833881-->

-->{{

cite journal | author=Campbell, G. R., Pasquier, E., Watkins, J., Bourgarel-Rey, V., Peyrot, V., Esquieu, D., Barbier, P., de Mareuil, J., Braguer, D., Kaleebu, P., Yirrell, D. L. and Loret E. P. | title=The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis | journal=J. Biol. Chem. | year=2004 | pages=48197–48204 | volume=279 | issue=46 | id={{PMID |15331610-->

-->{{

cite journal | author=Kaleebu P, French N, Mahe C, Yirrell D, Watera C, Lyagoba F, Nakiyingi J, Rutebemberwa A, Morgan D, Weber J, Gilks C, Whitworth J. | title=Effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression in a large cohort of HIV-1-positive persons in Uganda | journal=J. Infect. Dis. | year=2002 | pages=1244–1250 | volume=185 | issue=9 | id={{PMID |12001041-->

--> The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.

Diagnosis Since June 5, 1981, many definitions have been developed for epidemiology surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control and Prevention (CDC) Classification System is used.

WHO disease staging system for HIV infection and disease In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.{{

cite journal | author=World Health Organization | title=Interim proposal for a WHO staging system for HIV infection and disease | journal=WHO Wkly Epidem. Rec. | year=1990 | pages=221–228 | volume=65 | issue=29 | id={{PMID |1974812-->

--> An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

Stage I: HIV infection is asymptomatic and not categorized as AIDS
Stage II: includes minor Mucous membrane manifestations and recurrent upper respiratory tract infections
Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, Vertebrate trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

CDC classification system for HIV infection In the beginning, the Centers for Disease Control and Prevention (CDC) did not have an official name for the disease, often referring to it by way of the diseases that were associated with it, for example, lymphadenopathy, the disease after which the discoverers of HIV originally named the virus.{{

cite journal | author=Centers for Disease Control (CDC) | title=Persistent, generalized lymphadenopathy among homosexual males. | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=249–251 | volume=31| issue=19 | id={{PMID|6808340-->

--> | format= --> They also used Kaposi's Sarcoma and Opportunistic Infections, the name by which a task force had been set up in 1981.{{

cite journal | author=Centers for Disease Control (CDC) | title=Opportunistic infections and Kaposi's sarcoma among Haitians in the United States | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=353–354; 360–361 | volume=31 | issue=26 | id={{PMID|6811853-->

--> In the general press, the term GRID, which stood for Gay-Related Immune Deficiency, had been coined.{{

cite news | author=Altman, L.K. | title='New homosexual disorder worries officials' | work=New York Times | date=1982-05-11 | pages= |

--> However, after determining that AIDS was not isolated to the homosexual community, the term GRID became misleading and AIDS was introduced at a meeting in July 1982.{{

cite news | author=Kher, U. | title=A Name for the Plague | work=Time | date=1982-07-27 | url=http://www.time.com/time/80days/820727.html |

--> By September 1982 the CDC started using the name AIDS, and properly defined the illness.{{

cite journal | author=Centers for Disease Control (CDC) | title=Update on acquired immune deficiency syndrome (AIDS)—United States. | journal=MMWR Morb Mortal Wkly Rep. | year=1982 | pages=507–508; 513–514 | volume=31 | issue=37 | id={{PMID|6815471-->

--> In 1993, the CDC expanded their definition of AIDS to include all HIV positive people with a CD4+ T cell count below 200 per µL of blood or 14% of all lymphocytes.{{

cite web | publisher=CDC | year=1992 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/00018871.htm | title=1993 Revised Classification System for HIV Infection and Expanded Surveillance Case Definition for AIDS Among Adolescents and Adults | accessdate = 2006-02-09

--> The majority of new AIDS cases in Developed country use either this definition or the pre-1993 CDC definition. The AIDS diagnosis still stands even if, after treatment, the CD4+ T cell count rises to above 200 per µL of blood or other AIDS-defining illnesses are cured.

HIV test Many people are unaware that they are infected with HIV.

Less than 1% of the sexually active urban population in Africa has been tested, and this proportion is even lower in rural populations. Furthermore, only 0.5% of pregnant women attending urban health facilities are counseled, tested or receive their test results. Again, this proportion is even lower in rural health facilities.

Therefore, donor blood and blood products used in medicine and medical research are screened for HIV. Typical HIV tests, including the HIV enzyme immunoassay and the Western blot assay, detect HIV antibody in blood plasma, blood plasma, oral fluid, dried blood spot or urine of patients. However, the window period (the time between initial infection and the development of detectable antibodies against the infection) can vary. This is why it can take 3–6 months to seroconversion and test positive. Commercially available tests to detect other HIV antigens, HIV-RNA, and HIV-DNA in order to detect HIV infection prior to the development of detectable antibodies are available. For the diagnosis of HIV infection these assays are not specifically approved, but are nonetheless routinely used in developed countries.

Symptoms and complications ]

The symptoms of AIDS are primarily the result of conditions that do not normally develop in individuals with healthy immune systems. Most of these conditions are infections caused by bacteria, viruses, fungus and parasites that are normally controlled by the elements of the immune system that HIV damages. Opportunistic infections are common in people with AIDS.{{

cite journal | author=Holmes, C. B., Losina, E., Walensky, R. P., Yazdanpanah, Y., Freedberg, K. A. | title=Review of human immunodeficiency virus type 1-related opportunistic infections in sub-Saharan Africa | journal=Clin. Infect. Dis. | year=2003 | pages=656–662 | volume=36 | issue=5 | id={{PMID |12594648-->

--> HIV affects nearly every organ system. People with AIDS also have an increased risk of developing various cancers such as Kaposi's sarcoma, cervical cancer and cancers of the immune system known as lymphomas.

Additionally, people with AIDS often have systemic symptoms of infection like fevers, sweats (particularly at night), swollen glands, chills, weakness, and weight loss.{{

cite journal | author=Guss, D. A. | title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 1 | journal=J. Emerg. Med. | year=1994 | pages=375–384 | volume=12 | issue=3 | id={{PMID |8040596-->

-->{{

cite journal | author=Guss, D. A. | title=The acquired immune deficiency syndrome: an overview for the emergency physician, Part 2 | journal=J. Emerg. Med. | year=1994 | pages=491–497 | volume=12 | issue=4 | id={{PMID |7963396-->

--> After the diagnosis of AIDS is made, the current average survival time with antiretroviral therapy (as of 2005) is estimated to be more than 5 years,{{

cite journal | author=Schneider, M. F., Gange, S. J., Williams, C. M., Anastos, K., Greenblatt, R. M., Kingsley, L., Detels, R., and Munoz, A. | title=Patterns of the hazard of death after AIDS through the evolution of antiretroviral therapy: 1984–2004 | journal=AIDS | year=2005 | pages=2009–2018 | volume=19 | issue=17 | id={{PMID|16260908-->

--> but because new treatments continue to be developed and because HIV continues to evolve resistance to treatments, estimates of survival time are likely to continue to change. Without antiretroviral therapy, death normally occurs within a year. Most patients die from opportunistic infections or malignancies associated with the progressive failure of the immune system.{{

cite journal | author=Lawn, S. D. | title=AIDS in Africa: the impact of coinfections on the pathogenesis of HIV-1 infection | journal=J. Infect. Dis. | year=2004 | pages=1–12 | volume=48 | issue=1 | id={{PMID |14667787-->

-->

The rate of clinical disease progression varies widely between individuals and has been shown to be affected by many factors such as host susceptibility and immune function health care and co-infections, as well as factors relating to the viral strain.{{

cite journal | author=Campbell, G. R., Watkins, J. D., Esquieu, D., Pasquier, E., Loret, E. P. and Spector, S. A. | title=The C terminus of HIV-1 Tat modulates the extent of CD178-mediated apoptosis of T cells | journal=J. Biol. Chem. | year=2005 | pages=38376–39382 | volume=280 | issue=46 | id={{PMID |16155003-->

-->{{

cite journal | author=Senkaali, D., Muwonge, R., Morgan, D., Yirrell, D., Whitworth, J. and Kaleebu, P. | title=The relationship between HIV type 1 disease progression and V3 serotype in a rural Ugandan cohort | journal=AIDS Res. Hum. Retroviruses. | year=2005 | pages=932–937 | volume=20 | issue=9 | id={{PMID |15585080-->

--> The specific opportunistic infections that AIDS patients develop depend in part on the prevalence of these infections in the geographic area in which the patient lives.

Major pulmonary illnesses caused pneumonia. There is increased white (opacity) in the lower lungs on both sides, characteristic of Pneumocystis pneumonia

Pneumocystis pneumonia (PCP) (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis pneumonia (PCP). Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL.{{

cite journal | author=Feldman, C. | title=Pneumonia associated with HIV infection | journal=Curr. Opin. Infect. Dis. | year=2005 | pages=165–170 | volume=18 | issue=2 | id={{PMID|15735422-->

-->

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.{{

cite journal | author=Decker, C. F. and Lazarus, A. | title=Tuberculosis and HIV infection. How to safely treat both disorders concurrently | journal=Postgrad Med. | year=2000 | pages=57–60, 65–68 | volume=108 | issue=2 | id={{PMID|10951746-->

--> Alternatively, symptoms may relate more to the site of extrapulmonary involvement.

Major gastro-intestinal illnesses

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (Herpes simplex virus or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.{{

cite journal | author=Zaidi, S. A. and Cervia, J. S. | title=Diagnosis and management of infectious esophagitis associated with human immunodeficiency virus infection | journal=J. Int. Assoc. Physicians AIDS Care (Chic Ill) | year=2002 | pages=53–62 | volume=1 | issue=2 | id={{PMID|12942677-->

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Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria, Campylobacter, or Escherichia coli) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) colitis. In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.{{

cite journal | author=Guerrant, R. L., Hughes, J. M., Lima, N. L., Crane, J. | title=Diarrhea in developed and developing countries: magnitude, special settings, and etiologies | journal=Rev. Infect. Dis. | year=1990 | pages=S41–S50 | volume=12 | issue=Suppl 1 | id={{PMID|2406855-->

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Major neurological illnesses

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain causing toxoplasma encephalitis but it can infect and cause disease in the eyes and lungs.{{

cite journal | author=Luft, B. J. and Chua, A. | title=Central Nervous System Toxoplasmosis in HIV Pathogenesis, Diagnosis, and Therapy | journal=Curr. Infect. Dis. Rep. | year=2000 | pages=358–362 | volume=2 | issue=4 | id={{PMID|11095878-->

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Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in Virus latency form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.{{

cite journal | author=Sadler, M. and Nelson, M. R. | title=Progressive multifocal leukoencephalopathy in HIV | journal=Int. J. STD AIDS | year=1997 | pages=351–357 | volume=8 | issue=6 | id={{PMID|9179644-->

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AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia which secrete neurotoxins of both host and viral origin.{{

cite journal | author=Gray, F., Adle-Biassette, H., Chrétien, F., Lorin de la Grandmaison, G., Force, G., Keohane, C. | title=Neuropathology and neurodegeneration in human immunodeficiency virus infection. Pathogenesis of HIV-induced lesions of the brain, correlations with HIV-associated disorders and modifications according to treatments | journal=Clin. Neuropathol. | year=2001 | pages=146–155 | volume=20 | issue=4 | id={{PMID|11495003-->

--> Specific neurological impairments are manifested by cognitive, behavioral, and motor abnormalities that occur after years of HIV infection and is associated with low CD4+ T cell levels and high plasma viral loads. Prevalence is 10–20% in Western countries{{

cite book | author = Grant, I., Sacktor, H., and McArthur, J. | year = 2005 | title = The Neurology of AIDS | chapter = HIV neurocognitive disorders | chapterurl = http://www.hnrc.ucsd.edu/publications_pdf/2005grant1.pdf | editor = H. E. Gendelman, I. Grant, I. Everall, S. A. Lipton, and S. Swindells. (ed.) | edition = 2nd | pages = 357–373 | publisher = Oxford University Press | location = London, UK | format= PDF | id = ISBN 0-19-852610-5

--> but only 1–2% of HIV infections in India.{{

cite journal | author=Satishchandra, P., Nalini, A., Gourie-Devi, M., Khanna, N., Santosh, V., Ravi, V., Desai, A., Chandramuki, A., Jayakumar, P. N., and Shankar, S. K. | title=Profile of neurologic disorders associated with HIV/AIDS from Bangalore, South India (1989–1996) | journal=Indian J. Med. Res. | year=2000 | pages=14–23 | volume=11 | issue= | id={{PMID|10793489-->

-->{{

cite journal | author=Wadia, R. S., Pujari, S. N., Kothari, S., Udhar, M., Kulkarni, S., Bhagat, S., and Nanivadekar, A. | title=Neurological manifestations of HIV disease | journal=J. Assoc. Physicians India | year=2001 | pages=343–348 | volume=49 | issue= | id={{PMID|11291974-->

--> This difference is possibly due to the HIV subtype in India.

Cryptococcal meningitis is an infection of the meninges (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue (physical), nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Major HIV-associated malignancies

Patients with HIV infection have substantially increased incidence of several malignant cancers. This is primarily due to co-infection with an oncogene DNA virus, especially Epstein-Barr virus (EBV), Kaposi's sarcoma-associated herpesvirus (KSHV), and human papillomavirus (HPV).{{

cite journal | author=Boshoff, C. and Weiss, R. | title=AIDS-related malignancies | journal=Nat. Rev. Cancer | year=2002 | pages=373–382 | volume=2 | issue=5 | id={{PMID|12044013-->

-->{{

cite journal | author=Yarchoan, R., Tosatom G. and Littlem R. F. | title=Therapy insight: AIDS-related malignancies — the influence of antiviral therapy on pathogenesis and management | journal=Nat. Clin. Pract. Oncol. | year=2005 | pages=406–415 | volume=2 | issue=8 | id={{PMID|16130937-->

--> The following confer a diagnosis of AIDS when they occur in an HIV-infected person.

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a Gammaherpesvirinae virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).

In addition to the AIDS-defining tumors listed above, HIV-infected patients are at increased risk of certain other tumors, such as Hodgkin's disease and anal carcinoma and rectal carcinomas. However, the incidence of many common tumors, such as breast cancer or colon cancer, does not increase in HIV-infected patients. In areas where HAART is extensively used to treat AIDS, the incidence of many AIDS-related malignancies has decreased, but at the same time malignant cancers overall have become the most common cause of death of HIV-infected patients.{{

cite journal | author=Bonnet, F., Lewden, C., May, T., Heripret, L., Jougla, E., Bevilacqua, S., Costagliola, D., Salmon, D., Chene, G. and Morlat, P. | title=Malignancy-related causes of death in human immunodeficiency virus-infected patients in the era of highly active antiretroviral therapy | journal=Cancer | year=2004 | pages=317–324 | volume=101 | issue=2 | id={{PMID|15241829-->

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Other opportunistic infections AIDS patients often develop opportunistic infections that present with non-specific symptoms, especially low-grade fevers and weight loss. These include infection with Mycobacterium avium-intracellulare and cytomegalovirus (CMV). CMV can cause colitis, as described above, and Cytomegalovirus retinitis can cause blindness. Penicilliosis due to Penicillium marneffei is now the third most common opportunistic infection (after extrapulmonary tuberculosis and cryptococcosis) in HIV-positive individuals within the endemic area of Southeast Asia.{{

cite journal | author=Skoulidis, F., Morgan, M. S., and MacLeod, K. M. | title=Penicillium marneffei: a pathogen on our doorstep? | journal=J. R. Soc. Med.| year=2004 | pages=394–396 | volume=97 | issue=2 | id={{PMID|15286196-->

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Symptom resurgence The press reports specific symptom resurgence among AIDS patients undergoing treatment.

Kaposi's sarcoma in AIDS patients San Francisco doctors reported a Kaposi's sarcoma cluster among gay men. All 15 patients undergoing treatment are long-term HIV survivors whose HIV infections are firmly controlled with antiviral drugs. None appears to be in any danger. The new cases are not aggressive, invasive or lethal as was typical with uncontrolled HIV during the 1980s. The lesions are unsightly, difficult to treat and raise questions about the immune response of aging HIV survivors.{{cite web| url = http://www.sfgate.com/cgi-bin/article.cgi?f=/c/a/2007/10/11/MNEESOFRG.DTL| title = Unsettling re-emergence of 'gay cancer'| first = Sabin| last = Russell| date = [2007-10-11| accessdate = 2007-10-11 -->

Transmission and prevention {| class="prettytable" style="float:right; font-size:85%; margin-left:15px;"|- bgcolor="#efefef"|+ Estimated per act risk for acquisitionof HIV by exposure route{{

cite journal | author=Smith, D. K., Grohskopf, L. A., Black, R. J., Auerbach, J. D., Veronese, F., Struble, K. A., Cheever, L., Johnson, M., Paxton, L. A., Onorato, I. A. and Greenberg, A. E. | title=Antiretroviral Postexposure Prophylaxis After Sexual, Injection-Drug Use, or Other Nonoccupational Exposure to HIV in the United States | journal=MMWR | year=2005 | pages=1–20 | volume=54 | issue=RR02 | url=http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5402a1.htm#tab1

-->|- bgcolor="#efefef"! style="width: 100px" abbr="Route" | Exposure Route! style="width: 130px" abbr="Infections" | Estimated infectionsper 10,000 exposuresto an infected source|-! style="text-align:left"| Blood Transfusion| 9,000{{

cite journal | author=Donegan, E., Stuart, M., Niland, J. C., Sacks, H. S., Azen, S. P., Dietrich, S. L., Faucett, C., Fletcher, M. A., Kleinman, S. H., Operskalski, E. A., ''et al.'' | title=Infection with human immunodeficiency virus type 1 (HIV-1) among recipients of antibody-positive blood donations | journal=Ann. Intern. Med. | year=1990 | pages=733–739 | volume=113 | issue=10 | id={{PMID|2240875-->

-->|-! style="text-align:left"| Childbirth| 2,500{{

cite journal | author=Coovadia, H. | title=Antiretroviral agents—how best to protect infants from HIV and save their mothers from AIDS | journal=N. Engl. J. Med. | year=2004 | pages=289–292 | volume=351 | issue=3 | id=

-->|-! style="text-align:left"| Needle-sharing injection drug use| 67{{

cite journal | author=Kaplan, E. H. and Heimer, R. | title=HIV incidence among New Haven needle exchange participants: updated estimates from syringe tracking and testing data | journal=J. Acquir. Immune Defic. Syndr. Hum. Retrovirol. | year=1995 | pages=175–176 | volume=10 | issue=2 | id={{PMID|7552482-->

-->|-! style="text-align:left"| Receptive anal intercourse*| 50{{

cite journal | author=European Study Group on Heterosexual Transmission of HIV | title=Comparison of female to male and male to female transmission of HIV in 563 stable couples | journal=BMJ. | year=1992 | pages=809–813 | volume=304 | issue=6830 | id={{PMID|1392708-->

-->{{

cite journal | author=Varghese, B., Maher, J. E., Peterman, T. A., Branson, B. M. and Steketee, R. W. | title=Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use | journal=Sex. Transm. Dis. | year=2002 | pages=38–43 | volume=29 | issue=1 | id={{PMID|11773877-->

-->|-! style="text-align:left"| Percutaneous needle stick| 30{{

cite journal | author=Bell, D. M. | title=Occupational risk of human immunodeficiency virus infection in healthcare workers: an overview. | journal=Am. J. Med. | year=1997 | pages=9–15 | volume=102 | issue=5B | id={{PMID|9845490-->

-->|-! style="text-align:left"| Receptive penile-vaginal intercourse*| 10{{

cite journal | author=Leynaert, B., Downs, A. M. and de Vincenzi, I. | title=Heterosexual transmission of human immunodeficiency virus: variability of infectivity throughout the course of infection. European Study Group on Heterosexual Transmission of HIV | journal=Am. J. Epidemiol. | year=1998 | pages=88–96 | volume=148 | issue=1 | id={{PMID|9663408-->

-->|-! style="text-align:left"| Insertive anal intercourse*| 6.5|-! style="text-align:left"| Insertive penile-vaginal intercourse*| 5|-! style="text-align:left"| Receptive oral intercourse*| 1§|-! style="text-align:left"| Insertive oral intercourse*| 0.5§|- bgcolor="#efefef"! colspan=5 style="border-right:0px;";| * assuming no condom use
§ source refers to oral intercourseperformed on a man|}The three main transmission routes of HIV are sexual contact, exposure to infected body fluids or tissues, and from mother to fetus or child during perinatal period. It is possible to find HIV in the saliva, tears, and urine of infected individuals, but there are no recorded cases of infection by these secretions, and the risk of infection is negligible.

Sexual contact The majority of HIV infections are acquired through unprotected sexual relations between partners, one of whom has HIV. Heterosexual intercourse is the primary mode of HIV infection worldwide.Johnson AM and Laga M, Heterosexual transmission of HIV, AIDS, 1988, 2(suppl. 1):S49-S56; N'Galy B and Ryder RW, Epidemiology of HIV infection in Africa, Journal of Acquired Immune Deficiency Syndromes, 1988, 1(6):551-558; and Deschamps M et al., Heterosexual transmission of HIV in Haiti, Annals of Internal Medicine, 1996, 125(4):324-330.Sexual transmission occurs with the contact between sexual secretions of one partner with the rectal, genital or oral mucous membranes of another. Unprotected receptive sexual acts are riskier than unprotected insertive sexual acts, with the risk for transmitting HIV from an infected partner to an uninfected partner through unprotected anal intercourse greater than the risk for transmission through vaginal intercourse or oral sex. Oral sex is not without its risks as HIV is transmissible through both insertive and receptive oral sex.{{

cite journal | author=Rothenberg, R. B., Scarlett, M., del Rio, C., Reznik, D. and O'Daniels, C. | title=Oral transmission of HIV | journal=AIDS | year=1998 | pages=2095–2105 | volume=12 | issue=16 | id={{PMID|9833850-->

--> The risk of HIV transmission from exposure to saliva is considerably smaller than the risk from exposure to semen; contrary to popular belief, one would have to swallow gallons of saliva from a carrier to run a significant risk of becoming infected.{{

cite journal | author=Mastro TD, de Vincenzi I | title=Probabilities of sexual HIV-1 transmission | journal=AIDS | year=1996 | volume=10 | pages=S75–S82 | issue=Suppl A | id={{PMID|8883613-->

-->

Approximately 30% of women in ten countries representing "diverse cultural, geographical and urban/rural settings" report that their first sexual experience was forced or coerced, making sexual violence a key driver of the HIV/AIDS pandemic.{{

cite web | author=[World Health Organization | publisher=| year=2006 | url=http://www.who.int/gender/violence/who_multicountry_study/en/index.html | title=WHO Multi-country Study on Women's Health and Domestic Violence against Women | accessdate = 2006-12-14

--> Sexual assault greatly increases the risk of HIV transmission as protection is rarely employed and physical trauma to the vaginal cavity frequently occurs which facilitates the transmission of HIV.{{

cite journal | author=Koenig, Michael et al| title=Coerced first intercourse and reproductive health among adolescent women in Rakai, Uganda | journal=International Family Planning Perspectives| year=2004 | volume=30 | pages=156 | issue=4:156

-->

Sexually transmitted infections (STI) increase the risk of HIV transmission and infection because they cause the disruption of the normal epithelial barrier by genital ulceration and/or microulceration; and by accumulation of pools of HIV-susceptible or HIV-infected cells (lymphocytes and macrophages) in semen and vaginal secretions. Epidemiological studies from sub-Saharan Africa, Europe and North America have suggested that there is approximately a four times greater risk of becoming infected with HIV in the presence of a genital ulcer such as those caused by syphilis and/or chancroid. There is also a significant though lesser increased risk in the presence of STIs such as gonorrhea, Chlamydial infection and trichomoniasis which cause local accumulations of lymphocytes and macrophages.{{

cite journal | author=Laga, M., Nzila, N., Goeman, J. | title=The interrelationship of sexually transmitted diseases and HIV infection: implications for the control of both epidemics in Africa | journal=AIDS | year=1991 | pages=S55–S63 | volume=5 | issue=Suppl 1 | id={{PMID|1669925-->

-->

Transmission of HIV depends on the infectiousness of the index case and the susceptibility of the uninfected partner. Infectivity seems to vary during the course of illness and is not constant between individuals. An undetectable plasma viral load does not necessarily indicate a low viral load in the seminal liquid or genital secretions. Each 10-fold increment of blood plasma HIV RNA is associated with an 81% increased rate of HIV transmission.{{

cite journal | author=Tovanabutra, S., Robison, V., Wongtrakul, J., Sennum, S., Suriyanon, V., Kingkeow, D., Kawichai, S., Tanan, P., Duerr, A. and Nelson, K. E. | title=Male viral load and heterosexual transmission of HIV-1 subtype E in northern Thailand | journal=J. Acquir. Immune. Defic. Syndr. | year=2002 | pages=275–283 | volume=29 | issue=3 | id={{PMID|11873077-->

--> Women are more susceptible to HIV-1 infection due to hormonal changes, vaginal microbial ecology and physiology, and a higher prevalence of sexually transmitted diseases.{{

cite journal | author=Sagar, M., Lavreys, L., Baeten, J. M., Richardson, B. A., Mandaliya, K., Ndinya-Achola, J. O., Kreiss, J. K., and Overbaugh, J. | title=Identification of modifiable factors that affect the genetic diversity of the transmitted HIV-1 population | journal=AIDS | year=2004 | pages=615–619 | volume=18 | issue=4 | id={{PMID|15090766-->

-->{{

cite journal | author= Lavreys, L., Baeten, J. M., Martin, H. L. Jr., Overbaugh, J., Mandaliya, K., Ndinya-Achola, J., and Kreiss, J. K. | title=Hormonal contraception and risk of HIV-1 acquisition: results of a 10-year prospective study | journal=AIDS | year=2004 | pages=695–697 | volume=18 | issue=4 | id={{PMID|15090778-->

--> People who are infected with HIV can still be infected by other, more virulent strains.

During a sexual act, only male or female condoms can reduce the chances of infection with HIV and other STDs and the chances of becoming pregnant. The best evidence to date indicates that typical condom use reduces the risk of heterosexual HIV transmission by approximately 80% over the long-term, though the benefit is likely to be higher if condoms are used correctly on every occasion.{{

cite journal | author=Cayley, W. E. Jr. | title=Effectiveness of condoms in reducing heterosexual transmission of HIV | journal=Am. Fam. Physician | year=2004 | pages=1268–1269 | volume=70 | issue=7 | id={{PMID|15508535-->

--> The effective use of condoms and screening of blood transfusion in North America, Western and Central Europe is credited with contributing to the low rates of AIDS in these regions. Promoting condom use, however, has often proved controversial and difficult. Many religious groups, most noticeably the Roman Catholic Church, have opposed the use of condoms on religious grounds, and have sometimes seen condom promotion as an affront to the promotion of marriage, monogamy and sexual morality. Defenders of the Catholic Church's role in AIDS and general STD prevention state that, while they may be against the use of contraception, they are strong advocates of abstinence outside marriage.{{

cite book | author = Catholic Church | year = 1997 | title = Catechism of the Catholic Church : Second Edition | chapter = Offenses against chastity | chapterurl = http://www.scborromeo.org/ccc/p3s2c2a6.htm#II | pages = 2353 | publisher = Amministrazione Del Patrimonio Della Sede Apostolica | location = Vatican | accessdate = 2006-06-14

--> This attitude is also found among some health care providers and policy makers in sub-Saharan African nations, where HIV and AIDS prevalence is extremely high.{{

cite book | author = Human Rights Watch | year = 2005 | title = The Less They Know, the Better | chapter = Restrictions on Condoms | chapterurl = http://hrw.org/reports/2005/uganda0305/7.htm#_Toc98378385 | pages = | publisher = Human Rights Watch | location = New York NY

--> They also believe that the distribution and promotion of condoms is tantamount to promoting sex amongst the youth and sending the wrong message to uninfected individuals. However, no evidence has been produced that promotion of condom use increases sexual promiscuity,{{

cite journal | author=[No authors listed | title=Study shows condom use does not promote promiscuity. | journal=AIDS Policy Law. | year=1997 | pages=6–7 | volume=12| issue=12 | id={{PMID|11364411-->

--> and abstinence-only programs have been unsuccessful in the United States both in changing sexual behavior and in reducing HIV transmission.{{

cite web | author=[Human Rights Watch | url=http://www.hrw.org/reports/2002/usa0902/USA0902-04.htm | title=Ignorance only: HIV/AIDS, Human rights and federally funded abstinence-only programs in the United States. Texas: A case study | accessdate = 2006-03-28

--> Evaluations of several abstinence-only programs in the US showed a negative impact on the willingness of youths to use contraceptives, due to the emphasis on contraceptives' failure rates.{{

cite web | author=Debra Hauser | publisher=[Advocates for Youth | year=2004 | format=PDF | url=http://www.advocatesforyouth.org/publications/stateevaluations.pdf | title=Five Years of Abstinence-Only-Until-Marriage Education: Assessing the Impact | accessdate = 2006-06-07

-->The male latex condom, if used correctly without oil-based lubricants, is the single most effective available technology to reduce the sexual transmission of HIV and other sexually transmitted infections. Manufacturers recommend that oil-based lubricants such as petroleum jelly, butter, and lard not be used with latex condoms, because they dissolve the latex, making the condoms Porosity. If necessary, manufacturers recommend using water-based lubricants. Oil-based lubricants can however be used with polyurethane condoms.{{

cite web | author=[Durex | publisher= | year= | url=http://www.durex.com/cm/assets/SexEdDownloads/Module_5_condoms.doc | title=Module 5/Guidelines for Educators | format= [Microsoft Word | accessdate = 2006-04-17

--> Latex condoms degrade over time, making them porous, which is why condoms have expiration dates. In Europe and the United States, condoms have to conform to European (EC 600) or American (D3492) standards to be considered protective against HIV transmission.

The female condom is an alternative to the male condom and is made from polyurethane, which allows it to be used in the presence of oil-based lubricants. They are larger than male condoms and have a stiffened ring-shaped opening, and are designed to be inserted into the vagina. The female condom contains an inner ring, which keeps the condom in place inside the vagina — inserting the female condom requires squeezing this ring. However, at present availability of female condoms is very low and the price remains prohibitive for many women. Preliminary studies suggest that, where female condoms are available, overall protected sexual acts increase relative to unprotected sexual acts, making them an important HIV prevention strategy.{{

cite journal| author=PATH | title=The female condom: significant potential for STI and pregnancy prevention | journal=Outlook | year=2006 | volume=22 | issue=2

-->

With consistent and correct use of condoms, there is a very low risk of HIV infection. Studies on couples where one partner is infected show that with consistent condom use, HIV infection rates for the uninfected partner are below 1% per year.{{

cite web | author=[WHO | publisher= | year= August, 2003 | url=http://www.wpro.who.int/media_centre/fact_sheets/fs_200308_Condoms.htm | title=Condom Facts and Figures | acce {{Infobox_Disease |Name = Acquired immunodeficiency syndrome (AIDS) | Image = Red_Ribbon.svg | Caption = The [Red ribbon#AIDS awareness symbol is a symbol for solidarity with HIV-positive people and those living with AIDS. | Width = 120 | DiseasesDB = 5938 | ICD10 = {{ICD10|B|24||b|20--> | ICD9 = {{ICD9|042--> | ICDO = | OMIM = | MedlinePlus = 000594 | eMedicineSubj = emerg | eMedicineTopic = 253 | MeshID = D000163 | -->Acquired immune deficiency syndrome or acquired immunodeficiency syndrome (AIDS or Aids) is a syndrome resulting from the specific damage to the immune system caused by the HIV (HIV) in humans,{{cite journal | author=Marx, J. L. | title=New disease baffles medical community | journal=Science | year=1982 | pages=618–621 | volume=217 | issue=4560 | id={{PMID |7089584-->

--> and similar viruses in other species (Simian immunodeficiency virus, Feline immunodeficiency virus, etc.). The late stage of the condition leaves individuals susceptible to opportunistic infections and tumors. Although treatments for AIDS and HIV exist to decelerate the virus' progression, there is currently no known cure. HIV, et al., are Transmission (medicine) through direct contact of a mucous membrane or the bloodstream with a bodily fluid containing HIV, such as blood, semen, vaginal fluid, preseminal fluid, and breast milk.{{

cite web]| publisher=Centers for Disease Control & Prevention ]| publisher=| year= 2006-04-14, [vaginal sex or oral sex Sexual intercourse, blood transfusion, contaminated hypodermic needles, exchange between mother and baby during pregnancy, childbirth, or breastfeeding, or other exposure to one of the above bodily fluids.

Most researchers believe that HIV originated in sub-Saharan Africa during the twentieth century;

{{ cite journal], with an estimated 38.6 million people now living with the disease worldwide.{{

cite book]| year = 2006| title = 2006 Report on the global AIDS epidemic| chapter = Overview of the global AIDS epidemic| chapterurl = http://data.unaids.org/pub/GlobalReport/2006/2006_GR_CH02_en.pdf| accessdate = 2006-06-08| format= PDF--> As of January 2006, the Joint United Nations Programme on HIV/AIDS (UNAIDS) and the World Health Organization (WHO) estimate that AIDS has killed more than 25 million people since it was first recognized on June 5, 1981, making it one of the most destructive epidemics in recorded history. In 2005 alone, AIDS claimed an estimated 2.4–3.3 million lives, of which more than 570,000 were children. A third of these deaths are occurring in sub-Saharan Africa, retarding economic growth and destroying human capital. antiretroviral drug treatment reduces both the Mortality rate and the morbidity of HIV infection, but routine access to antiretroviral medication is not available in all countries.{{

cite journal] is more severe than that associated with other life-threatening conditions and extends beyond the disease itself to providers and even volunteers involved with the care of people living with HIV.

Infection by HIV of HIV-1 budding from cultured lymphocyte.

AIDS is the most severe acceleration of infection with HIV. HIV is a retrovirus that primarily infects vital organs of the human immune system such as T helper cell (a subset of T cells), macrophages and dendritic cells. It directly and indirectly destroys CD4+ T cells. CD4+ T cells are required for the proper functioning of the immune system. When HIV kills CD4+ T cells so that there are fewer than 200 CD4+ T cells per microliter (µL) of blood, cellular immunity is lost, leading to the condition known as AIDS. Acute (medical) HIV infection progresses over time to clinical latent HIV infection and then to early symptomatic HIV infection and later to AIDS, which is identified on the basis of the amount of CD4+ T cells in the blood and the presence of certain infections.

In the absence of antiretroviral drugs, the median HIV Disease Progression Rates is nine to ten years, and the median survival time after developing AIDS is only 9.2 months.{{

cite journal | author=Morgan, D., Mahe, C., Mayanja, B., Okongo, J. M., Lubega, R. and Whitworth, J. A. | title=HIV-1 infection in rural Africa: is there a difference in median time to AIDS and survival compared with that in industrialized countries? | journal=AIDS | year=2002 | pages=597–632 | volume=16 | issue=4 | id={{PMID |11873003-->

--> However, the rate of clinical disease progression varies widely between individuals, from two weeks up to 20 years. Many factors affect the rate of progression. These include factors that influence the body's ability to defend against HIV such as the infected person's general immune function.{{

cite journal | author=Clerici, M., Balotta, C., Meroni, L., Ferrario, E., Riva, C., Trabattoni, D., Ridolfo, A., Villa, M., Shearer, G.M., Moroni, M. and Galli, M. | title=Type 1 cytokine production and low prevalence of viral isolation correlate with long-term non progression in HIV infection | journal=AIDS Res. Hum. Retroviruses. | year=1996 | pages=1053–1061 | volume=12 | issue=11 | id={{PMID |8827221-->

-->{{

cite journal | author=Morgan, D., Mahe, C., Mayanja, B. and Whitworth, J. A. | title=Progression to symptomatic disease in people infected with HIV-1 in rural Uganda: prospective cohort study | journal=BMJ | year=2002 | pages=193–196 | volume=324 | issue=7331 | id={{PMID |11809639-->

--> Older people have weaker immune systems, and therefore have a greater risk of rapid disease progression than younger people. Poor access to health care and the existence of coexisting infections such as tuberculosis also may predispose people to faster disease progression.{{

cite journal | author=Gendelman, H. E., Phelps, W., Feigenbaum, L., Ostrove, J. M., Adachi, A., Howley, P. M., Khoury, G., Ginsberg, H. S. and Martin, M. A. | title=Transactivation of the human immunodeficiency virus long terminal repeat sequences by DNA viruses | journal=Proc. Natl. Acad. Sci. U. S. A. | year=1986 | pages=9759–9763 | volume=83 | issue=24 | id={{PMID |2432602-->

-->{{

cite journal | author=Bentwich, Z., Kalinkovich., A. and Weisman, Z. | title=Immune activation is a dominant factor in the pathogenesis of African AIDS. | journal=Immunol. Today | year=1995 | pages=187–191 | volume=16 | issue=4 | id={{PMID |7734046-->

--> The infected person's genetics plays an important role and some people are resistance (biology) to certain strains of HIV. An example of this is people with the CCR5-Δ32 mutation are resistant to infection with certain strain (biology) of HIV.{{

cite journal | author=Tang, J. and Kaslow, R. A. | title=The impact of host genetics on HIV infection and disease progression in the era of highly active antiretroviral therapy | journal=AIDS | year=2003 | pages=S51–S60 | volume=17 | issue=Suppl 4 | id={{PMID |15080180-->

--> HIV is genetically variable and exists as different strains, which cause different rates of clinical disease progression.{{

cite journal | author=Quiñones-Mateu, M. E., Mas, A., Lain de Lera, T., Soriano, V., Alcami, J., Lederman, M. M. and Domingo, E. | title=LTR and tat variability of HIV-1 isolates from patients with divergent rates of disease progression | journal=Virus Research | year=1998 | pages=11–20 | volume=57 | issue=1 | id={{PMID |9833881-->

-->{{

cite journal | author=Campbell, G. R., Pasquier, E., Watkins, J., Bourgarel-Rey, V., Peyrot, V., Esquieu, D., Barbier, P., de Mareuil, J., Braguer, D., Kaleebu, P., Yirrell, D. L. and Loret E. P. | title=The glutamine-rich region of the HIV-1 Tat protein is involved in T-cell apoptosis | journal=J. Biol. Chem. | year=2004 | pages=48197–48204 | volume=279 | issue=46 | id={{PMID |15331610-->

-->{{

cite journal | author=Kaleebu P, French N, Mahe C, Yirrell D, Watera C, Lyagoba F, Nakiyingi J, Rutebemberwa A, Morgan D, Weber J, Gilks C, Whitworth J. | title=Effect of human immunodeficiency virus (HIV) type 1 envelope subtypes A and D on disease progression in a large cohort of HIV-1-positive persons in Uganda | journal=J. Infect. Dis. | year=2002 | pages=1244–1250 | volume=185 | issue=9 | id={{PMID |12001041-->

--> The use of highly active antiretroviral therapy prolongs both the median time of progression to AIDS and the median survival time.

Diagnosis Since June 5, 1981, many definitions have been developed for epidemiology surveillance such as the Bangui definition and the 1994 expanded World Health Organization AIDS case definition. However, clinical staging of patients was not an intended use for these systems as they are neither sensitive, nor specific. In developing countries, the World Health Organization staging system for HIV infection and disease, using clinical and laboratory data, is used and in developed countries, the Centers for Disease Control and Prevention (CDC) Classification System is used.

WHO disease staging system for HIV infection and disease In 1990, the World Health Organization (WHO) grouped these infections and conditions together by introducing a staging system for patients infected with HIV-1.{{

cite journal | author=World Health Organization | title=Interim proposal for a WHO staging system for HIV infection and disease | journal=WHO Wkly Epidem. Rec. | year=1990 | pages=221–228 | volume=65 | issue=29 | id={{PMID |1974812-->

--> An update took place in September 2005. Most of these conditions are opportunistic infections that are easily treatable in healthy people.

Stage I: HIV infection is asymptomatic and not categorized as AIDS
Stage II: includes minor Mucous membrane manifestations and recurrent upper respiratory tract infections
Stage III: includes unexplained chronic diarrhea for longer than a month, severe bacterial infections and pulmonary tuberculosis
Stage IV: includes toxoplasmosis of the brain, candidiasis of the esophagus, Vertebrate trachea, bronchi or lungs and Kaposi's sarcoma; these diseases are indicators of AIDS.

Pneumocystis pneumonia (PCP) (originally known as Pneumocystis carinii pneumonia, and still abbreviated as PCP, which now stands for Pneumocystis pneumonia) is relatively rare in healthy, immunocompetent people, but common among HIV-infected individuals. It is caused by Pneumocystis pneumonia (PCP). Before the advent of effective diagnosis, treatment and routine prophylaxis in Western countries, it was a common immediate cause of death. In developing countries, it is still one of the first indications of AIDS in untested individuals, although it does not generally occur unless the CD4 count is less than 200 per µL.{{

cite journal | author=Feldman, C. | title=Pneumonia associated with HIV infection | journal=Curr. Opin. Infect. Dis. | year=2005 | pages=165–170 | volume=18 | issue=2 | id={{PMID|15735422-->

-->

Tuberculosis (TB) is unique among infections associated with HIV because it is transmissible to immunocompetent people via the respiratory route, is easily treatable once identified, may occur in early-stage HIV disease, and is preventable with drug therapy. However, multidrug resistance is a potentially serious problem. Even though its incidence has declined because of the use of directly observed therapy and other improved practices in Western countries, this is not the case in developing countries where HIV is most prevalent. In early-stage HIV infection (CD4 count >300 cells per µL), TB typically presents as a pulmonary disease. In advanced HIV infection, TB often presents atypically with extrapulmonary (systemic) disease a common feature. Symptoms are usually constitutional and are not localized to one particular site, often affecting bone marrow, bone, urinary and gastrointestinal tracts, liver, regional lymph nodes, and the central nervous system.{{

Esophagitis is an inflammation of the lining of the lower end of the esophagus (gullet or swallowing tube leading to the stomach). In HIV infected individuals, this is normally due to fungal (candidiasis) or viral (Herpes simplex virus or cytomegalovirus) infections. In rare cases, it could be due to mycobacteria.{{

Unexplained chronic diarrhea in HIV infection is due to many possible causes, including common bacterial (Salmonella, Shigella, Listeria, Campylobacter, or Escherichia coli) and parasitic infections; and uncommon opportunistic infections such as cryptosporidiosis, microsporidiosis, Mycobacterium avium complex (MAC) and cytomegalovirus (CMV) colitis. In some cases, diarrhea may be a side effect of several drugs used to treat HIV, or it may simply accompany HIV infection, particularly during primary HIV infection. It may also be a side effect of antibiotics used to treat bacterial causes of diarrhea (common for Clostridium difficile). In the later stages of HIV infection, diarrhea is thought to be a reflection of changes in the way the intestinal tract absorbs nutrients, and may be an important component of HIV-related wasting.{{

Toxoplasmosis is a disease caused by the single-celled parasite called Toxoplasma gondii; it usually infects the brain causing toxoplasma encephalitis but it can infect and cause disease in the eyes and lungs.{{

Progressive multifocal leukoencephalopathy (PML) is a demyelinating disease, in which the gradual destruction of the myelin sheath covering the axons of nerve cells impairs the transmission of nerve impulses. It is caused by a virus called JC virus which occurs in 70% of the population in Virus latency form, causing disease only when the immune system has been severely weakened, as is the case for AIDS patients. It progresses rapidly, usually causing death within months of diagnosis.{{

AIDS dementia complex (ADC) is a metabolic encephalopathy induced by HIV infection and fueled by immune activation of HIV infected brain macrophages and microglia which secrete neurotoxins of both host and viral origin.{{

Cryptococcal meningitis is an infection of the meninges (the membrane covering the brain and spinal cord) by the fungus Cryptococcus neoformans. It can cause fevers, headache, fatigue (physical), nausea, and vomiting. Patients may also develop seizures and confusion; left untreated, it can be lethal.

Kaposi's sarcoma (KS) is the most common tumor in HIV-infected patients. The appearance of this tumor in young homosexual men in 1981 was one of the first signals of the AIDS epidemic. Caused by a Gammaherpesvirinae virus called Kaposi's sarcoma-associated herpes virus (KSHV), it often appears as purplish nodules on the skin, but can affect other organs, especially the mouth, gastrointestinal tract, and lungs.
High-grade B cell lymphomas such as Burkitt's lymphoma, Burkitt's-like lymphoma, diffuse large B-cell lymphoma (DLBCL), and primary central nervous system lymphoma present more often in HIV-infected patients. These particular cancers often foreshadow a poor prognosis. In some cases these lymphomas are AIDS-defining. Epstein-Barr virus (EBV) or KSHV cause many of these lymphomas.
Cervical cancer in HIV-infected women is considered AIDS-defining. It is caused by human papillomavirus (HPV).

What is AIDS?
Facts about AIDS and HIV: What is AIDS? How can you be infected with HIV? Facts about how HIV develops into AIDS, and advice on avoiding transmission.

HIV & AIDS in countries and regions
Detailed info about HIV and AIDS epidemics in specific countries and regions around the world, including China, India and Brazil.

HIV and AIDS Introduction - Health encyclopaedia - NHS Direct
HIV ... What is HIV? The Human Immunodeficiency Virus (HIV) is a sexually transmitted virus (STI) that attacks the body's immune system, which provides a natural defence system ...

BBC News | AIDS | What is Aids?
There is still no cure for Aids, but drug treatments can reduce the virulence of HIV, the virus that causes Aids. ... There is still no cure for Aids, but a combination of various ...

BBC - Health - Conditions - AIDS
HIV and AIDS is a growing health problem ... HIV and AIDS. Dr Rob Hicks. The human immunodeficiency virus (HIV) infects and gradually destroys immune system cells, reducing the ...

AIDS.ORG: Educating - Raising HIV Awareness - Building Community
Non-profit organization for the free and open exchange of information in the fight against AIDS.

Aids Orphans in Africa
Sponsor a child with SOS Children in any of 124 countries: Aids Orphans in Africa ... Aids Africa Children: HIV / AIDS Orphans. We are all becoming more and more aware of the scale ...

Youreableshop Disability Aids & Mobility Products - Living Is Easier ...
Disability Aids and Mobility Aids for Disabled and Elderly, Products to Aid Daily Living, Mobility scooters, Incontinence and Bathlifts. ... At Youreable Shop we offer an extensive ...

HIV and AIDS
HIV means 'human immunodeficiency virus'. As with all other kinds of virus, HIV does not have an individual metabolism and, therefore, has to attack other living cells and use ...

Aids and HIV | World news | guardian.co.uk
Aids and HIV ... Jul 17 2008: A gene that once protected people of African descent from malaria is now making them more susceptible to HIV infection